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, � CHECK OFF LIST FOR ISSUAi�tCE OF PERNIITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3y� Z (.,�v� ��s�-c�N <br /> PID: <br /> DESCRIP'TION OF WORK: (,4,24 b c. �-,p� � 'R �•� <br /> ZO�G REV�`V BY: DATE APPROVED: G • zl -C� <br /> BUII.DI�i tG REVIE`V BY: DATE APPROVID; b •Lc -cx) <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes ✓ No <br /> PLAN REVIEW Yes �/' No SEWER CONNECTION <br /> STATE SURCHARGE Yes _� No WATERCONNEC"TION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZO�u CH�CK LIST Zoning District: G.R-�G <br /> Fire Departmenr. ;NW�nn� Post O�ce: v,JA��,-�vt-Tra School District: �.�25��>�� <br /> Lot Area: Sq.ft. /3�2�v Acres • 3 � Width ��� Depth l 3Z <br /> Survey Submitted: Yes � No Date of Survey: 7-1��4�! <br /> Proposed Setbacks: <br /> Fron[ (Lake): 51 � f Right Side: �O � ^' <br /> Rear(Street): 3Z � f' Left Side: � � � <br /> Adjacent Structures: i 5� Wetland: i.!/r4 . <br /> Building Height: Def. Hgt. c�, (�- Peal:Hgt. — <br /> L.ot Coverage: j/.3 6 �� <br /> Grading: Staff Approval Date: --- By: Council Approval Date: <br /> Septic: Staff Approval Date: """ By: <br /> Zoning File: # -- Resolution: # -- Resolution Date: <br /> Shoreland District: Nv <br /> Avg. Setback: Bluff Setback: I,ot Coverage: <br /> Eusting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REI�LARKS (in house): <br /> 7 <br />